Urban Built Environments and Trajectories of Disability Among Older Adults

描述（由申请人提供）：老年人特别依赖当地社区，由于健康和功能状况下降、经济压力和社会孤立，他们很容易受到城市建筑环境障碍的影响（例如交通拥挤、不安全的人行道和缺乏行人设施）。然而，人造环境对老年人独立性的影响尚未得到充分研究。本研究的目的是了解建筑环境在残疾发展中的作用。具体来说，该项目的目的有三个：1)详细描述社区居住老年人高危人群的周围建筑环境；2)研究建筑环境与残疾发展之间的关系；3)确定随着时间的推移，居住在交通不便的社区的老年人是否更有可能进入养老院。研究目标将通过二级数据分析项目进行调查，利用现有的基于人口的数据（密歇根州家庭护理最小数据集），结合定量多层次方法和地理信息系统（CIS）软件。潜在轨迹类分析将被用来检验城市可达性和城市设计对行动障碍和随后的养老院入住轨迹的影响，为期15个月。将获得适当使用地理信息系统和空间分析技术进行这项研究所需的技能，作为职业发展计划的关键组成部分。候选人将利用密歇根大学和其他地方的广泛资源和培训机会，获得必要的技能，以追求研究事业，适当地将以人为本的变量置于人们衰老的更大的社会和环境背景中。目前关于晚年健康和独立的研究几乎完全侧重于个人层面的因素。然而，周围环境的作用可能在老年人独立和依赖模式的形成中发挥关键作用。该项目解决了疾病预防控制中心的健康保护目标之一，即“健康的人在健康的地方”，重点是为有残疾风险的老年人设计确定健康社区的建筑环境。

DESCRIPTION (provided by applicant): Older adults are particularly dependent on their local communities, and due to declining health and functional status, financial strain and social isolation, are vulnerable to barriers in the urban built environment (e.g. heavy traffic, unsafe sidewalks, and a lack of pedestrian amenities). Yet the effect of the built environment on independence in older adults is under-studied. The purpose of this research is to understand the role of the built environment in disability progression. Specifically, the aims of this project are threefold: 1) to characterize in detail the surrounding built environment for a high risk population of community-dwelling older adults; 2) to examine the relationship between the built environment and disability progression; and 3) to identify whether older adults living in less accessible neighborhoods are more likely to be admitted to a nursing home over time. The research objectives will be investigated through a program of secondary data analysis with existing population-based data (Michigan Minimum Data Set for Home Care) using a combination of quantitative multilevel methods and geographic information systems (CIS) software. Latent trajectory class analysis will be used to examine the effect of urban accessibility and urban design on trajectories of mobility disability and subsequent nursing home admission over a 15 month period. The skills needed to appropriately use GIS and spatial analysis techniques for this research will be obtained as a key component of the career development plan. The candidate will draw on a broad range of resources and training opportunities throughout the University of Michigan and elsewhere, to obtain the necessary skills to pursue a research career that appropriately situates person-centered variables within the larger social and environmental context in which people age. Current research on later life health and independence places almost exclusive emphasis on factors at the individual level. Yet, the role of the surrounding environment may play a key role in shaping patterns of independence and dependence among older adults. This project addresses one of CDC's Health Protection Goals, "Healthy People in Healthy Places", by focusing on the design of built environments that define healthy communities for older adults at risk for disability.